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Scopolamine Toxicity in an Elderly Patient.
Kayla M Knuf1, Francis M Spaulding1, Gregory J Stevens1
1Department of Anesthesia, Brooke Army Medical Center, 3551 Rodger Brooke Dr, Ft Sam Houston, TX 78234.
Military Medicine
|April 21, 2019
Summary
A 66-year-old patient experienced delayed emergence after surgery due to an anti-cholinergic toxicity from a scopolamine patch. This case highlights the need for careful patient selection in Enhanced Recovery After Surgery (ERAS) protocols.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Pharmacology
Background:
- Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative care.
- Transdermal scopolamine is sometimes used for postoperative nausea and vomiting prophylaxis.
Observation:
- A 66-year-old female on the ERAS protocol developed delayed emergence postoperatively.
- Physical examination revealed a transdermal scopolamine patch near skin breakdown, with signs of central anti-cholinergic toxicity (mydriasis, tachycardia).
Findings:
- Scopolamine patch removal and physostigmine administration led to the patient's mental status returning to baseline.
- The patient's age and potential for altered drug metabolism were contributing factors.
Implications:
- This case underscores the importance of individualized risk-benefit assessments for medications within ERAS protocols.
- Careful consideration of patient-specific factors, such as age and skin integrity, is crucial when administering transdermal medications like scopolamine.
- Highlights the potential for anticholinergic toxicity in elderly patients receiving scopolamine, even within a perioperative protocol.
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